Obama's plans on health care a tough sell among seniors

Senior citizens are emerging as a formidable obstacle to President Obama's ambitious health-care plans.

The discontent in the powerful, highly organized voting bloc has risen to such a level that the administration is scrambling to devise a strategy to woo older Americans.

Obama's task will not be easy. Proposals to squeeze more than $500 billion out of the growth of Medicare in the next decade have fueled fears that his effort to expand coverage to millions of younger, uninsured Americans will damage elder care. As a result, barely one-third of seniors support a health-care overhaul, polls have found.

"People have gotten more and more worried," said Nancy LeaMond, a vice president at the 50-and-older advocacy group AARP, which today will unveil a TV and print ad campaign supporting health-care change. "They are very concerned about the myths they keep hearing that care will be rationed and they won't have access to doctors."

One mailing from the 60 Plus Association, which bills itself as a "conservative alternative to AARP," warns that the proposed Medicare changes will mean "longer wait times at hospitals and doctors offices, less money for new treatments, restrictions on care, prescriptions and what's best for you — the patient!" Officials at the Virginia-based group did not respond to several messages last week.

Conservative talk-radio shows have raised the prospect of euthanasia based on a provision to reimburse doctors through Medicare for counseling sessions about end-of-life directives.

And comments posted on former Alaska Republican Gov. Sarah Palin's Facebook page Friday said people would have to "stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care."

There are no such "death panels" mentioned in the House legislation.

From the raw numbers, seniors appear to be the net losers under a bill approved by three House committees. The legislation trims $563 billion out of Medicare's growth rate over 10 years while pumping in about $320 billion. Without changes, the government-run program is expected to cost about $6.4 trillion over the same period.

But three retiree groups and several independent policy analysts say most proposed savings affect providers, rather than beneficiaries, and have the potential to improve quality over the long term. Discounts for prescription drugs, higher reimbursements for many doctors and elimination of co-payments for preventive services are applauded by advocates.

"I don't see anything that will affect beneficiaries' access to care, though some of it will depend on implementation," said Joseph Baker, president of the Medicare Rights Center, a nonprofit focused on older Americans.

Senior citizens long have had doubts about Obama. Voters 65 and older were the only age group to choose Sen. John McCain, R-Ariz., in last year's presidential election, according to exit polling.

"They are more risk-averse; they wanted more experience and less change," said Democratic pollster Celinda Lake, who tracks retiree attitudes. On health care, seniors see "very rapid change, and in an area they don't want change."

The overhaul Obama envisioned would expand insurance coverage to about 46 million people. But seniors have comprehensive coverage through the federal Medicare program, which cost $453 billion this year. For them, an overhaul of health care represents a threat to care they like, Lake said.

"They only want to hear one thing: that their Medicare benefits won't be affected," she said. That message, she added, has not been conveyed adequately by Obama, congressional Democrats and "third-party validators."

Administration officials said Saturday that they are considering several options for reaching out to skeptical seniors, including a "myth-busting" Web site and public appearances by the president.

Diane Rowland, executive vice president of the nonprofit Kaiser Family Foundation, said House legislation does not "address all of the issues in Medicare that seniors would like to see addressed," including money for long-term care. But prescription-drug discounts and provisions that would extend the Medicare Trust Fund for at least five years are "an attempt to reassure the Medicare population."

Under the House bill, insurance companies that sell managed-care plans known as Medicare Advantage would take the largest hit. The independent Medicare Payment Advisory Commission has recommended reducing payments under Medicare Advantage, noting that insurance plans touted as being more efficient should not cost 14 percent more than the traditional fee-for-service Medicare policy.

Insurers say the extra money provides benefits such as eye care, dental and gym memberships — benefits that could be eliminated if the 10-year, $156 billion reduction occurs. Although the industry's lobbyists have spoken against the change, the criticism has been muted in the hopes that health-care legislation will deliver millions of new customers.

Hospitals also would receive smaller-than-anticipated payments under the House legislation. One provision would slash payments to hospitals that have high readmission rates. Medicare estimates that 19 percent of the unpleasant, costly readmissions are "preventable." Another proposed change would "bundle" fees for packages of care such as knee replacement to encourage medical teams to coordinate care from an initial assessment through surgery and rehabilitation.

The hospital industry has pledged to make $155 billion in reductions over the next decade as part of health reform, and AARP has endorsed the changes.

But the organization, which has a separate business unit that sells insurance, has objected to some proposals, including an Obama-backed plan to empower an independent advisory board to decide Medicare coverage and payment policies.